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including labels to clearly identify patient name, solution content and the time that it needs to be given to the patient. A technician then picks the materials and

drugs needed, using the earliest expiring units, and delivers them into the preparation room along with the protocol duly signed. The preparation technician dispenses all

drugs under the supervision of a professional, with both signing the protocol to indicate the real weight or volume dispensed beside the specified amount. Once the preparation is finished, both the

labelled container and the protocol shall be sent for a visual inspection and a check that all operations have been properly carried out, and upon approval the solution is sent to the Intensive Care Unit (ICU) for administration to the patient. Protocol shall be filed.

Room design In recent years, healthcare centers have started to compete using stylish hospital rooms as an additional feature for patients to consider when choosing a hospital. It is not

It is important to demonstrate to staff that their hands, skin and breath are laden with microbia.

unusual for hospitals to be promoted today with virtual tours, as if they were a five star hotel and including photographs of rooms with sofas and flowers. Unfortunately, sometimes style comes at the expense of good design. Hard to clean elements, materials that do not accept sanitisation or sterilisation and non-cleanable walls and paint are some of the most frequent problems and this can put the patient at greater risk of developing a healthcare acquired infection (HAI). Architects should be able to use colours

and light to provide a pleasant environment for the patient without compromising the real function of the room, which is to hold a patient in a safe environment. Another important issue is that of cross

contamination. Infections developed in a hospital environment are now less frequent than in the past, but they do still exist in almost every healthcare center. There are two main vehicles for cross-

E. coli

contamination: air and surfaces. The usual way to prevent airborne particles from exiting a confined environment is to produce a pressure differential – usually 10 to 15 Pa (.04 to .06 – between adjacent rooms. This can be achieved by adjusting the return air flow once the air changes have been adjusted by the air inflow. There is a widely believed perception that the greater the pressure differential, the

better protected an area is. But it is not so. If you increase the pressure above a certain level, the opening of a door will create a turbulent area around its edges, inducing air to flow randomly between the two areas, and with this comes a risk of infected particles being carried in the wrong direction. Particles or microorganisms carried by a

contaminated surface are very common. For example, leaving restricted areas of a hospital using the same footwear (going to lunch or to the parking lot) would result in the shoes being contaminated by the dirt found in the streets, or carried into the hospital on the shoes of visitors and transferred to the floor of the visitors’ area. Using booties when going to a moderately

contamination loaded area, such as the hospital lobby, may be of help. However, this would not be a suitable solution for leaving the building as harsh surfaces would tear through non-woven boots very quickly. As a general rule, it is important to assume that any contact between a clean surface and a dirty surface will only produce two dirty surfaces. So, stepping in the same place where

somebody has been walking with dirty shoes makes your shoes dirty. This is the case with most hospital changing rooms. When personnel arrive from the street, they take off their outdoor shoes and put them in a locker. Then they take their internal footwear from the locker and put them on, walking back over the same floor that they have just walked over with their outdoor shoes. The ideal dressing room would, therefore

be a long, narrow one with a continuous bench running from end-to-end and dividing into two parts. The entrance door should be at one end of the ‘dirty’ side where the lockers for the street clothes are. The person can then undress and put their street clothes and shoes in one locker. Then, making a simple half turn on the bench they will be facing a clean garments locker. After putting these on they can walk through the clean side to the door that leads directly into the hospital restricted area. Because nurses and maids undertake the largest part of patient handling in any healthcare center it is important to focus on them when training personnel. It is important to demonstrate to staff that

norovirus 68

their hands, skin and breath are laden with microbia, and that, no matter how long or how hard they scrub their hands, these will return after a while. .


CDC/Charles D. Humphrey

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